This is a renewal application for the K24 award entitled Epidemiology and Outcomes of Digestive and Liver Diseases: A Mentoring Program. During the past 4 years, I have accomplished the stated goals of the original K24, and have had considerable success in mentoring, research, and overall career in academic medicine. My training and research objectives for this award are: (1) to produce researchers who are trained in the content areas, methods, and ethics critical for epidemiology and health services research in gastroenterology and hepatology. (2) to produce scientists who will pursue a research agenda that will further discoveries in disease etiology and management, make the best use of current discoveries to make the health care more effective. (3) to continue to pursue independently funded patient oriented research in the epidemiology and outcomes of Barrett's esophagus (BE), hepatitis C virus (HCV) and hepatocellular carcinoma (HCC). For the first two objectives, I will serve as the director for the newly T-32 funded post doctoral research training, apply for T32 renewal in 2013, and increase the number of trainees. I also plan on pursuing a similar mentoring program with junior MD, and PhD faculty. For both, I propose to attract and train additional qualified mentors, and thereby force multiply mentoring capacity. For the third objective, my patient oriented research focuses on the epidemiology and outcomes of digestive disorders with funded projects on BE, HCV and HCC. For example, I plan to conduct a study entitled Comparative Effectiveness of Screening and Surveillance EGD Endoscopy. The rationale for this study is unclarity for the comparative effectiveness (CE) of screening endoscopy in patients with GERD symptoms (vs. no screening) or among different surveillance strategies (frequency, intensity) due to lack of strong evidence-based findings for GERD/BE population at risk of EA. With the use of large VA Medicare integrated electronic medical data repositories, we will conduct a cohort study to address the following aims. Aim #1. To compare the risk (detection rate) and outcomes (stage, treatment, survival) of EA among patients undergoing different intensities of screening and surveillance endoscopy. We hypothesize that screening (vs. none) and surveillance endoscopy (once every 2 years, or once every 3 years vs. none,) will increase: 1) likelihood of patients being diagnosed at early stage EA; 2) likelihood of patients receiving treatments for EA; and decrease 3) risk of EA-specific mortality. Aim #2. To identify predictors of desired outcomes of EA (low incidence and low EA mortality). Potential predictors include demographic features (e.g., age), GERD features (e.g., duration), interventions (e.g., PPI, ASA/NSAID; fundoplication; ablation), and other BE risk factors (e.g., obesity, smoking). Aim #3. To elicit patients' and physicians' risk perceptions, outcome expectancies and affective responses to alternative endoscopic screening and surveillance strategies. Data from these in- depth qualitative interviews will be used to inform the design of potential interventions to enhance the dissemination and implementation of the key findings from this CE research. PUBLIC HEALTH RELEVANCE: The goal of this application is to implement a mentoring and research program to produce researchers who are trained in the methods, and ethics critical for epidemiology and health services research in digestive disease.